Institut Claudius Regaud, Toulouse, France.
Int J Gynecol Cancer. 2012 Oct;22(8):1337-43. doi: 10.1097/IGC.0b013e31826a3559.
To evaluate the outcome of maximal cytoreductive surgery in patients with stage IIIC to stage IV ovarian, tubal, and peritoneal cancer regarding overall survival (OS) and disease-free survival (DFS).
Five hundred twenty-seven patients with stage IIIC (peritoneal) and stage IV (pleural) ovarian, fallopian tube, and peritoneal carcinoma underwent surgery between January 2003 and December 2007 in 7 gynecologic oncology centers in France. Patients undergoing primary and interval debulking surgery were included, whichever the number of chemotherapy cycles. The extent of disease, type of surgical procedure, and amount of residual disease were recorded. A multivariate analysis of the outcome was performed, taking into account the stage, grade, and timing of surgery.
Median DFS was 17.9 months, but median OS was not reached at the time of analysis. Complete cytoreductive surgery, without evident residual tumor at the end of the procedure, was obtained in 71% of all patients (primary surgery, 33%). After neoadjuvant therapy, the rate of complete debulking surgery was higher (74%) compared to primary cytoreductive surgery (65%). Twenty-three percent of patients needed "ultra radical surgery" to achieve this goal. The most significant predictive factor for DFS and OS was complete cytoreductive surgery compared to any amount, even minimal (1-10 mm), of residual disease. In the group of patients with complete cytoreductive surgery, the patients undergoing surgery before chemotherapy showed better DFS than those having first chemotherapy.
The findings confirm that complete cytoreduction is the criterion standard of surgery in the management of advanced ovarian, peritoneal, and fallopian tube cancer, whatever the timing of surgery. With experienced teams, surgery was completed, without evident residual tumor in 71% of the cases.
评估 IIIC 期至 IV 期卵巢、输卵管和腹膜癌患者接受最大程度细胞减灭术治疗的总生存（OS）和无病生存（DFS）结果。
2003 年 1 月至 2007 年 12 月，法国 7 个妇科肿瘤中心对 527 例 IIIC（腹膜）期和 IV（胸膜）期卵巢、输卵管和腹膜癌患者进行了手术。包括接受原发性和间隔性肿瘤细胞减灭术的患者，无论化疗周期数如何。记录疾病的严重程度、手术类型和残余肿瘤量。对结果进行了多变量分析，考虑了分期、分级和手术时机。
中位 DFS 为 17.9 个月，但在分析时未达到中位 OS。所有患者中有 71%（原发性手术 33%）获得了完全细胞减灭术，术中无明显残余肿瘤。与原发性肿瘤细胞减灭术相比（65%），新辅助治疗后完全肿瘤细胞减灭术的比例更高（74%）。23%的患者需要进行“超根治性手术”来达到这一目标。DFS 和 OS 的最显著预测因素是与任何量（即使是最小的（1-10mm））残余肿瘤相比，完全细胞减灭术。在完全细胞减灭术患者组中，先手术再化疗的患者DFS 优于先化疗再手术的患者。
研究结果证实，完全肿瘤细胞减灭术是晚期卵巢、腹膜和输卵管癌治疗的手术标准，无论手术时机如何。在经验丰富的团队的努力下，71%的病例完成了手术，且术中无明显残余肿瘤。
